9 ms·

The Degradation Drug

177 points by DkNiemand0 4y ago

gjsman-1000 4y ago
I read this story and… I’m actually terrified that our government has just signed-off on drugs like this. Between that, and the FDA not catching Theranos, it does make me afraid of the FDA’s competence or judgement for allowing such things so loosely.
metadat 4y ago
> But soon his euphoria was accompanied by an insatiable libido. Leonard became a “wild, wonderful, ravening man-beast,” masturbating for hours on end. Is going for a few hours unusual? If so, I've been in big trouble ever since I turned 14.. (now going on 39) It just feels really good. Hmm.
- owlninja 4y ago
  The only other similar stories I've heard like this are people using meth.
  - metadat 4y ago
    Nah, no meth, coke, or other recreational drugs. #bornthisway ?
- tasty_freeze 4y ago
  Since you are being unusually candid about your sexual practices on the internet, I'll similarly break protocol and ask: how has all this long duration masturbation affected your ability to reach orgasm with a sexual partner?
  - metadat 4y ago
    Not a problem, with a partner is the best way! I've learned to have some control, it's all in your head.
- RC_ITR 4y ago
  Not really the place to display your kink, man. Plenty of dedicated spaces on the Internet for that - a space being dedicated to sexual activity greatly increases the chance that a user consents to seeing that sort of content. But if lack of consent is what you're going for, then please explore CBT options for moderating that behavior.
  - metadat 4y ago
    I don't believe it's a kink, a rather natural part of being human. If this upsets you, here, have a chill pill (). Or maybe don't browse with showdead.
    - RC_ITR 4y ago
      You can do that as much as you want. The kink is telling people who didn’t ask. >Or maybe don't browse with showdead "You shouldn't call me out for my behavior because other people already showed their disapproval of it in a more passive/less specific way!"
  - InCityDreams 4y ago
    >Not really the place to display your kink, man. Masterbating for hours isn't a kink. What you masterbate to, is. And "man"? Could be female.
    - RC_ITR 4y ago
      Specifically compared himself to a cis man. And yes exhibitionism is a kink. Maybe I’ll put it this way, you’re assuming he wasn’t turned on by the idea of you specifically reading that comment and you’re probably wrong. Why else state how good it feels? If you're ok with that, congratulations, it's a match, but most people are not.
uptownfunk 4y ago
Here’s a hypothesis that would be interesting to test. As the younger generation continues its obsession with social media technology. Is there some physiological change (perhaps mimicd by the medication in the article) that could be happening simultaneously? Some weird type of brain evolution.
- urthor 4y ago
  I feel like this is already tested, extensively, by the "video games cause school shootings" crowd.
  - matheusmoreira 4y ago
    That particular claim is bullshit but it is true that video games can cause physiological changes and even harm. Like social media, video games today are straight up designed to be addictive. They're essentially Skinner's boxes but the reward lever is the player's credit card. Not only can addiction of any sort cause physiological changes in the reward center of the brain, video games can also impact physical, social and financial well being by virtue of being an expensive, addictive, sedentary and often isolated activity. Video game addiction is already a recognized medical diagnosis in ICD-11. https://www.who.int/news/item/14-09-2018-inclusion-of-gaming-disorder-in-icd-11 https://www.who.int/news/item/14-09-2018-inclusion-of-gaming...
deleted 4y ago
[deleted]
somebodynew 4y ago
The article describes its first subject as having been diagnosed with simply "depression", but describes their medication regime as including lithium and lamotrigine which in combination is strongly suggestive of treatment for bipolar depression in particular. Given that the described behavior sounds very much like a manic episode, the article should have explained this connection before attempting to focus the blame on pramipexole. Most antidepressants, even SSRIs, are medically recognized as potentially triggering mania in bipolar patients. While compulsive gambling and hypersexuality are associated with dopamine agonists, I think it may be misleading for the article to focus so heavily on a possible manic episode without discussing bipolar disorder at all and while implying that this was a unique effect of dopamine agonists.
- tbalsam 4y ago
  I agree about it sounding like a manic episode a lot. If I were to put up an opposing opinion -- some caveats here: cluster B disorders and autism both can include lithium (and symptoms not too dissimilar from mania), lamotrigine too on the BPD front. Mood stabilizers are prescribed in combination for a variety of conditions, I feel like it's a rather large jump to make. Also, Moda and a Benzodiazepine are going to do incredible amounts for the dopaminergic system, as well as lowering social punishment-conditioned fear responses. If someone is borderline manic, that could cause a lot of problems. Pramipexole is a seriously hardcore drug, I'd encourage you to look into it specifically over other dopamine agonists if you haven't already. I survived one day before deciding it wasn't worth it, personally. Plus, dopamine agonists can screw some things up about you semi-permanently, so that's a risk, too. It really feels like a grapeshot cannon from her psychiatrist, to be honest. I don't know her specific situation, but some of the rapid-acting antidepressants have good effects (like Ketamine, which operates I believe on D2, among other things). Just a few thoughts. I dx' people casually from very little data as a weak point myself (did it today, sorta, in retrospect to be honest), so partially this comment is my internal warning systems triggering on an external comment. Also, I wanted to put a different opinion so HN readers could get a different potential aide.
  - somebodynew 4y ago
kache_ 4y ago
belkarx 4y ago
The disease casually mentioned (https://en.wikipedia.org/wiki/Encephalitis_lethargica https://en.wikipedia.org/wiki/Encephalitis_lethargica) in the article is worth looking into as well - a ?virus? that causes coma, that appeared, wreaked havoc (affected ~1M people and killed half) for a decade or so, then disappeared
- jeffmc 4y ago
  Yeah, with the possible connection to the Spanish Flu epidemic this gives one pause when considering long covid and covid's neurological effects in general
jjtheblunt 4y ago
- jjtheblunt 4y ago
girvo 4y ago
> It is a rare case of restless legs syndrome that is severe enough to make the risk of prison time or the sex-offender registry look like a reasonable tradeoff. While I understand the rest of the article, as someone who has been through opioid-withdrawal induced RLS a few times in my life, this is really downplaying how horrible it is. The RLS alone would stop me from sleeping for a week or more. You lose your mind. It’s horrific. I can understand why someone with a severe case might be willing to take that risk — though from the sounds of it, a lot of prescribers aren’t explaining that risk to their patients. As an aside, for those who are unaware, RLS is induced by opioid withdrawal because chronic opioid use disorder/abuse down-regulates your dopamine receptors. Our dopamine pathways have wide reaching effects within our bodies and minds.
- koprulusector 4y ago
  I’m not an addict but I have suffered from restless leg syndrome in the past, to the severity you describe. Every time you’re on the cusp of sleep, there’s this tickle that travels up your leg to your lower back. But it’s this weird, disembodied tickle. There’s nothing to scratch or press or wrap or anything to alleviate. So you’re now wide awake because of this tickling sensation. This was ~2016 for me. I read somewhere that restless leg is related to signals in your nervous system, which needs electrolytes to work optimally, and that taking a magnesium supplement would help. I bought some magnesium at Walgreens and took them for about a month. I think I’ve only experienced restless leg once or twice since 2016. FYI, I hope this helps.
  - tecleandor 4y ago
    I was prescribed Pramipexole for restless leg syndrome some years ago, and the information leaflet was pretty specific about the impulsive behavior side effects. The Spanish leaflet lists as "Frequent" (up to 1 out of 10 patients) things like: "Needs to behave in an unusual way", "Hallucinations", "Confusion", "abnormal dreams", "Insomnia"... I in fact had lots of weird dreams and nightmares. It also lists as "Less frequent" (up to 1 out of 100) things like: "Paranoia", "Delusion", "Amnesia", "Hyperkinesis", "Fainting", "Concerns", "Inability to resist the impulse, instinct or temptation to take an action that may be harmful to yourself or others, which may include: [buy/gamble/sex/eat]"... I thankfully had none of that, but 1% looks like a too high probability for me for that kind of effects.
jackblemming 4y ago
It's hard to have much sympathy for this woman, after hearing she euthanized her cat on a whim. She blamed the drugs, her psychiatrist- pretty much everything but herself!
- uhhyeahdude 4y ago
  You’re actually getting at some of the issues the article explores. The case studies are there to illustrate; they’re not the central point. I almost dismissed the piece based on the headline, but I’m glad I didn’t. You might find it unexpectedly interesting too. If I misjudged whether or not you read the OP, my sincere apologies. No harm intended.
- pjc50 4y ago
  You could rephrase that to "murdered her cat while under the influence of mind-altering prescription drugs used with inadequate supervision". People in states of mental illness have diminished responsibility for their behavior.
- poulpy123 4y ago
  I don't know her but the drug is really known to make some people crazy
- NoGravitas 4y ago
  The self doesn't exist; the drugs do.
quickthrower2 4y ago
> euthanized her cat on a whim. this is the scary bit. Killing animals for fun is how many serial killers get started.
- DharmaPolice 4y ago
  It's not really clear how she euthanized her cat. That would seem pretty important.
  - quickthrower2 4y ago
    True. Also whether she previously “felt sorry” for the cat for some reason, maybe it was sick and suffering and the drug just switched her mind.
tempestn 4y ago
It seems to me that issues like this one expose a fundamental flaw with how criminal justice is generally practiced - one that's evident in the term itself. The focus is on assigning blame and just (fair) punishment. ISTM a better framing might be to determine the desired outcome and how best to achieve it. How likely is someone to re-offend, and what is the best intervention to reduce that likelihood? In the most extreme cases that might mean physically preventing recidivism through imprisonment. In other cases there might be other interventions that could be more beneficial. How likely are others to commit a similar crime, and to what extent, if any, will the outcome of this case affect that (ie deterrence)? And yes, also relevant is how will people - especially victims - feel about the outcome? Does it seem just? However if different norms around the response to crimes were established, feelings would presumably change as well, gradually. I'm not saying that no one should ever be punished for their crimes, just that the intent of punishment, or of any other intervention, should be to have positive impacts on the future, as opposed to simply an abstract balancing of scales. From that point of view, I expect the handling of cases like these would become significantly simpler.
- NoGravitas 4y ago
  > The focus is on assigning blame and just (fair) punishment. ISTM a better framing might be to determine the desired outcome and how best to achieve it. How likely is someone to re-offend, and what is the best intervention to reduce that likelihood? That would be rational, and, especially in the US, our criminal justice system very rarely intersects with rationality. In general, it's based on what will provide the most extreme emotional response among voters.
- AbrahamParangi 4y ago
  I think you dramatically underestimate the harshness of a “rational” system. According to one study 63% of violent crimes are committed by 1% of the population (your mileage may vary but the order of magnitudes will be about the same). This implies that a person that commits any violent crime should be imprisoned for an extremely long time, because the odds are very good that they’ll assault, rape, rob or murder someone else. Said another way, with the policy of locking people up for a very very long time on a first (violent) offense, you would eliminate nearly half of all violent crime- and that’s not even counting the deterrent effect.
k__ 4y ago
I read in body building forums that those who are on testosterone take cabergolin to keep their male breast from changing too much. Some of them said it made them more sexually active than before. They got horny more often and the refractory period was reduced. When I read about caber, I found out it was given to Parkinson patients and that one of it main side effects was that people were more inclined to gamble and have sex.
- runnerup 4y ago
  Interesting, anecdotally testosterone therapy (even unnaturally super high levels) tends to counteract my ADHD impulsiveness and the obsessive or prurient behaviors driven by dopamine reuptake inhibitors like amphetamine. Because of the descriptions of dopamine agonists, I suspect pramipexole and cabergolin have a much strong effect than DRI's. But maybe I've just lived with DRI's for so long that I can mitigate/resist the effects somewhat better than a person who just started on them in their middle age. Based on personal experimentation I also suspect the elevated estrogen from testosterone replacement is largely responsible for the reduction in dopamine-driven behaviors. I tend to do best overall with estradiol on the high side of normal. When estrogens are low I get far more compulsive behaviors shadowing those in TFA, even in the absence of dopamine related pharmaceuticals.
xlii 4y ago
Mesmerizing read. I found it very relatable because as a person trying to manage ADHD those experienced traits and behaviors during treatments are very similar to my untreated ones. I keep my dark side "on the leash" and maybe it's not as vibrant as ones in story (probably because I was born with it and had chance to adjust over years) but some similarities are uncanny. With various treatment experiences I had I start to believe that there is no "I" in anyone. It's just an effect of a brain chemistry on which we have very limited effect. Identity that's effect of trauma or treatment is just as real as the one we were born with. Ethical implications are very interesting, but in reality I doubt anything will change until we have a breakthrough in neurosciences. Even then probably there would be question if we should equalize people different. Feels like a plot for sci-fi movie - there even was one like that: https://www.imdb.com/title/tt0238380/ https://www.imdb.com/title/tt0238380/
taylorius 4y ago
Slightly off-topic (though related). I think I experience a mild form of the craziness described in the article if I don't get enough sleep the night before. I'm not trying to compare the two in any way, or make it "all about me" - but it's a definite pattern I've observed, and I wondered if anyone else had experienced anything similar.
- kayodelycaon 4y ago
  One possibility is you have always had that craziness but you learned to compensate for it using various strategies. But when you’re low on mental energy, you can’t compensate effectively. I experience this in an extreme way having bipolar. I learned very young how to function despite a severe disability. Lack of sleep would make everything worse because I couldn’t keep on top of things. When you’re in the middle of it, it feels normal.
- user_7832 4y ago
  This is not particularly surprising, lack of sleep causes an increase in dopamine (the theory is that the brain tries to "compensate"). There was a very recent episode on the Huberman Lab podcast on using this to "reset" the circadian rhythm and depression (to some extent).
deleted 4y ago
[deleted]
BizarroLand 4y ago
While reading the article I got the feeling that this article touched on something much deeper than it meant to. In stories there has often been a artistic, dreamy, head in the clouds type that either delights or confuses the more stolid, logical, sensible and practical other character. Abbot and Costello, Rabbit and Briar Fox, Dexter and Dee-Dee, Billy and Mandy, Drop Dead Fred and everyone else in that movie, (or anyone in a Yahoo Serious movie other than Yahoo Serious) these dualistic Gemini archetypes are littered throughout western culture, and quite possibly others but I don't know them well enough to bring any popular characters to mind. I wonder how much of that is caused by the fundamental divide between high and low dopamine functioning people? Wild, zany, brash and in your face manic lifestyle caused primarily by having a lot of dopamine in your brain? With plenty of people around to facilitate the outcome at least in part because of the attention-seeking nature of the effect? This makes me long to attempt something similar. It makes me wonder who I would be on a long arc dopamine rush. Would I paint? Would I sing? Would I drive my friends and coworkers wild? Or lose everything in a dopamine fueled fumbling towards ecstasy? Who knows, but it's intriguing! It's as tempting as a siren song. If someone had those pills in front of me right now I don't know if I could resist trying them.
rincebrain 4y ago
I've actually been taking pramipexole for almost two years now for depression which mostly didn't blink for anything else in the past. I certainly do behave differently while on it, but not in a way that I think anyone who knew me would claim is inconsistent with my prior personality or behavior, just...less likely to fall into the inertial well that is depression stifling your actions. A strange anecdote, though - my doctor told me when I was tapering up on it "okay, for some medications they tell you you might feel ill taking it initially, but no, for this, I am going to promise you, you will feel sick, and how well you can tolerate feeling sick is going to be the limiter on how fast we taper this", and he was correct, though it was never that bad during the initial taper up, just mild discomfort... ...then one day, the pharmacy gave me 1x1mg pills instead of 4x0.25mg pills, from the same manufacturer, and suddenly I had horrific nausea if I was in anything moving faster than a brisk walk for hours after taking it, and it went away when I went back to the 4x0.25mg. Which was wild, as I've never had motion sickness from anything before. (It's also twice a day because the half-life is real short now, which is annoying, but c'est la vie.) Feel free to ask anything that comes to mind about it, if anecdata interests you.
deleted 4y ago
[deleted]
HH_Slm 4y ago

177 points by DkNiemand0 4y ago

I read this story and… I’m actually terrified that our government has just signed-off on drugs like this. Between that, and the FDA not catching Theranos, it does make me afraid of the FDA’s competence or judgement for allowing such things so loosely.

metadat 4y ago

> But soon his euphoria was accompanied by an insatiable libido. Leonard became a “wild, wonderful, ravening man-beast,” masturbating for hours on end. Is going for a few hours unusual? If so, I've been in big trouble ever since I turned 14.. (now going on 39) It just feels really good. Hmm.

owlninja 4y ago
The only other similar stories I've heard like this are people using meth.
- metadat 4y ago
  Nah, no meth, coke, or other recreational drugs. #bornthisway ?
tasty_freeze 4y ago
Since you are being unusually candid about your sexual practices on the internet, I'll similarly break protocol and ask: how has all this long duration masturbation affected your ability to reach orgasm with a sexual partner?
- metadat 4y ago
  Not a problem, with a partner is the best way! I've learned to have some control, it's all in your head.
RC_ITR 4y ago
Not really the place to display your kink, man. Plenty of dedicated spaces on the Internet for that - a space being dedicated to sexual activity greatly increases the chance that a user consents to seeing that sort of content. But if lack of consent is what you're going for, then please explore CBT options for moderating that behavior.
- metadat 4y ago
  I don't believe it's a kink, a rather natural part of being human. If this upsets you, here, have a chill pill (). Or maybe don't browse with showdead.
  - RC_ITR 4y ago
    You can do that as much as you want. The kink is telling people who didn’t ask. >Or maybe don't browse with showdead "You shouldn't call me out for my behavior because other people already showed their disapproval of it in a more passive/less specific way!"
- InCityDreams 4y ago
  >Not really the place to display your kink, man. Masterbating for hours isn't a kink. What you masterbate to, is. And "man"? Could be female.
  - RC_ITR 4y ago
    Specifically compared himself to a cis man. And yes exhibitionism is a kink. Maybe I’ll put it this way, you’re assuming he wasn’t turned on by the idea of you specifically reading that comment and you’re probably wrong. Why else state how good it feels? If you're ok with that, congratulations, it's a match, but most people are not.

uptownfunk 4y ago

Here’s a hypothesis that would be interesting to test. As the younger generation continues its obsession with social media technology. Is there some physiological change (perhaps mimicd by the medication in the article) that could be happening simultaneously? Some weird type of brain evolution.

urthor 4y ago
I feel like this is already tested, extensively, by the "video games cause school shootings" crowd.
- matheusmoreira 4y ago
  That particular claim is bullshit but it is true that video games can cause physiological changes and even harm. Like social media, video games today are straight up designed to be addictive. They're essentially Skinner's boxes but the reward lever is the player's credit card. Not only can addiction of any sort cause physiological changes in the reward center of the brain, video games can also impact physical, social and financial well being by virtue of being an expensive, addictive, sedentary and often isolated activity. Video game addiction is already a recognized medical diagnosis in ICD-11. https://www.who.int/news/item/14-09-2018-inclusion-of-gaming-disorder-in-icd-11 https://www.who.int/news/item/14-09-2018-inclusion-of-gaming...

deleted 4y ago

[deleted]

somebodynew 4y ago

The article describes its first subject as having been diagnosed with simply "depression", but describes their medication regime as including lithium and lamotrigine which in combination is strongly suggestive of treatment for bipolar depression in particular. Given that the described behavior sounds very much like a manic episode, the article should have explained this connection before attempting to focus the blame on pramipexole. Most antidepressants, even SSRIs, are medically recognized as potentially triggering mania in bipolar patients. While compulsive gambling and hypersexuality are associated with dopamine agonists, I think it may be misleading for the article to focus so heavily on a possible manic episode without discussing bipolar disorder at all and while implying that this was a unique effect of dopamine agonists.

tbalsam 4y ago
I agree about it sounding like a manic episode a lot. If I were to put up an opposing opinion -- some caveats here: cluster B disorders and autism both can include lithium (and symptoms not too dissimilar from mania), lamotrigine too on the BPD front. Mood stabilizers are prescribed in combination for a variety of conditions, I feel like it's a rather large jump to make. Also, Moda and a Benzodiazepine are going to do incredible amounts for the dopaminergic system, as well as lowering social punishment-conditioned fear responses. If someone is borderline manic, that could cause a lot of problems. Pramipexole is a seriously hardcore drug, I'd encourage you to look into it specifically over other dopamine agonists if you haven't already. I survived one day before deciding it wasn't worth it, personally. Plus, dopamine agonists can screw some things up about you semi-permanently, so that's a risk, too. It really feels like a grapeshot cannon from her psychiatrist, to be honest. I don't know her specific situation, but some of the rapid-acting antidepressants have good effects (like Ketamine, which operates I believe on D2, among other things). Just a few thoughts. I dx' people casually from very little data as a weak point myself (did it today, sorta, in retrospect to be honest), so partially this comment is my internal warning systems triggering on an external comment. Also, I wanted to put a different opinion so HN readers could get a different potential aide.
- somebodynew 4y ago

kache_ 4y ago

belkarx 4y ago

The disease casually mentioned (https://en.wikipedia.org/wiki/Encephalitis_lethargica https://en.wikipedia.org/wiki/Encephalitis_lethargica) in the article is worth looking into as well - a ?virus? that causes coma, that appeared, wreaked havoc (affected ~1M people and killed half) for a decade or so, then disappeared

jeffmc 4y ago
Yeah, with the possible connection to the Spanish Flu epidemic this gives one pause when considering long covid and covid's neurological effects in general

jjtheblunt 4y ago

jjtheblunt 4y ago

girvo 4y ago

> It is a rare case of restless legs syndrome that is severe enough to make the risk of prison time or the sex-offender registry look like a reasonable tradeoff. While I understand the rest of the article, as someone who has been through opioid-withdrawal induced RLS a few times in my life, this is really downplaying how horrible it is. The RLS alone would stop me from sleeping for a week or more. You lose your mind. It’s horrific. I can understand why someone with a severe case might be willing to take that risk — though from the sounds of it, a lot of prescribers aren’t explaining that risk to their patients. As an aside, for those who are unaware, RLS is induced by opioid withdrawal because chronic opioid use disorder/abuse down-regulates your dopamine receptors. Our dopamine pathways have wide reaching effects within our bodies and minds.

koprulusector 4y ago
I’m not an addict but I have suffered from restless leg syndrome in the past, to the severity you describe. Every time you’re on the cusp of sleep, there’s this tickle that travels up your leg to your lower back. But it’s this weird, disembodied tickle. There’s nothing to scratch or press or wrap or anything to alleviate. So you’re now wide awake because of this tickling sensation. This was ~2016 for me. I read somewhere that restless leg is related to signals in your nervous system, which needs electrolytes to work optimally, and that taking a magnesium supplement would help. I bought some magnesium at Walgreens and took them for about a month. I think I’ve only experienced restless leg once or twice since 2016. FYI, I hope this helps.
- tecleandor 4y ago
  I was prescribed Pramipexole for restless leg syndrome some years ago, and the information leaflet was pretty specific about the impulsive behavior side effects. The Spanish leaflet lists as "Frequent" (up to 1 out of 10 patients) things like: "Needs to behave in an unusual way", "Hallucinations", "Confusion", "abnormal dreams", "Insomnia"... I in fact had lots of weird dreams and nightmares. It also lists as "Less frequent" (up to 1 out of 100) things like: "Paranoia", "Delusion", "Amnesia", "Hyperkinesis", "Fainting", "Concerns", "Inability to resist the impulse, instinct or temptation to take an action that may be harmful to yourself or others, which may include: [buy/gamble/sex/eat]"... I thankfully had none of that, but 1% looks like a too high probability for me for that kind of effects.

jackblemming 4y ago

It's hard to have much sympathy for this woman, after hearing she euthanized her cat on a whim. She blamed the drugs, her psychiatrist- pretty much everything but herself!

uhhyeahdude 4y ago
You’re actually getting at some of the issues the article explores. The case studies are there to illustrate; they’re not the central point. I almost dismissed the piece based on the headline, but I’m glad I didn’t. You might find it unexpectedly interesting too. If I misjudged whether or not you read the OP, my sincere apologies. No harm intended.
pjc50 4y ago
You could rephrase that to "murdered her cat while under the influence of mind-altering prescription drugs used with inadequate supervision". People in states of mental illness have diminished responsibility for their behavior.
poulpy123 4y ago
I don't know her but the drug is really known to make some people crazy
NoGravitas 4y ago
The self doesn't exist; the drugs do.

quickthrower2 4y ago

> euthanized her cat on a whim. this is the scary bit. Killing animals for fun is how many serial killers get started.

DharmaPolice 4y ago
It's not really clear how she euthanized her cat. That would seem pretty important.
- quickthrower2 4y ago
  True. Also whether she previously “felt sorry” for the cat for some reason, maybe it was sick and suffering and the drug just switched her mind.

tempestn 4y ago

It seems to me that issues like this one expose a fundamental flaw with how criminal justice is generally practiced - one that's evident in the term itself. The focus is on assigning blame and just (fair) punishment. ISTM a better framing might be to determine the desired outcome and how best to achieve it. How likely is someone to re-offend, and what is the best intervention to reduce that likelihood? In the most extreme cases that might mean physically preventing recidivism through imprisonment. In other cases there might be other interventions that could be more beneficial. How likely are others to commit a similar crime, and to what extent, if any, will the outcome of this case affect that (ie deterrence)? And yes, also relevant is how will people - especially victims - feel about the outcome? Does it seem just? However if different norms around the response to crimes were established, feelings would presumably change as well, gradually. I'm not saying that no one should ever be punished for their crimes, just that the intent of punishment, or of any other intervention, should be to have positive impacts on the future, as opposed to simply an abstract balancing of scales. From that point of view, I expect the handling of cases like these would become significantly simpler.

NoGravitas 4y ago
> The focus is on assigning blame and just (fair) punishment. ISTM a better framing might be to determine the desired outcome and how best to achieve it. How likely is someone to re-offend, and what is the best intervention to reduce that likelihood? That would be rational, and, especially in the US, our criminal justice system very rarely intersects with rationality. In general, it's based on what will provide the most extreme emotional response among voters.
AbrahamParangi 4y ago
I think you dramatically underestimate the harshness of a “rational” system. According to one study 63% of violent crimes are committed by 1% of the population (your mileage may vary but the order of magnitudes will be about the same). This implies that a person that commits any violent crime should be imprisoned for an extremely long time, because the odds are very good that they’ll assault, rape, rob or murder someone else. Said another way, with the policy of locking people up for a very very long time on a first (violent) offense, you would eliminate nearly half of all violent crime- and that’s not even counting the deterrent effect.

k__ 4y ago

I read in body building forums that those who are on testosterone take cabergolin to keep their male breast from changing too much. Some of them said it made them more sexually active than before. They got horny more often and the refractory period was reduced. When I read about caber, I found out it was given to Parkinson patients and that one of it main side effects was that people were more inclined to gamble and have sex.

runnerup 4y ago
Interesting, anecdotally testosterone therapy (even unnaturally super high levels) tends to counteract my ADHD impulsiveness and the obsessive or prurient behaviors driven by dopamine reuptake inhibitors like amphetamine. Because of the descriptions of dopamine agonists, I suspect pramipexole and cabergolin have a much strong effect than DRI's. But maybe I've just lived with DRI's for so long that I can mitigate/resist the effects somewhat better than a person who just started on them in their middle age. Based on personal experimentation I also suspect the elevated estrogen from testosterone replacement is largely responsible for the reduction in dopamine-driven behaviors. I tend to do best overall with estradiol on the high side of normal. When estrogens are low I get far more compulsive behaviors shadowing those in TFA, even in the absence of dopamine related pharmaceuticals.

xlii 4y ago

Mesmerizing read. I found it very relatable because as a person trying to manage ADHD those experienced traits and behaviors during treatments are very similar to my untreated ones. I keep my dark side "on the leash" and maybe it's not as vibrant as ones in story (probably because I was born with it and had chance to adjust over years) but some similarities are uncanny. With various treatment experiences I had I start to believe that there is no "I" in anyone. It's just an effect of a brain chemistry on which we have very limited effect. Identity that's effect of trauma or treatment is just as real as the one we were born with. Ethical implications are very interesting, but in reality I doubt anything will change until we have a breakthrough in neurosciences. Even then probably there would be question if we should equalize people different. Feels like a plot for sci-fi movie - there even was one like that: https://www.imdb.com/title/tt0238380/ https://www.imdb.com/title/tt0238380/

taylorius 4y ago

Slightly off-topic (though related). I think I experience a mild form of the craziness described in the article if I don't get enough sleep the night before. I'm not trying to compare the two in any way, or make it "all about me" - but it's a definite pattern I've observed, and I wondered if anyone else had experienced anything similar.

kayodelycaon 4y ago
One possibility is you have always had that craziness but you learned to compensate for it using various strategies. But when you’re low on mental energy, you can’t compensate effectively. I experience this in an extreme way having bipolar. I learned very young how to function despite a severe disability. Lack of sleep would make everything worse because I couldn’t keep on top of things. When you’re in the middle of it, it feels normal.
user_7832 4y ago
This is not particularly surprising, lack of sleep causes an increase in dopamine (the theory is that the brain tries to "compensate"). There was a very recent episode on the Huberman Lab podcast on using this to "reset" the circadian rhythm and depression (to some extent).

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BizarroLand 4y ago

While reading the article I got the feeling that this article touched on something much deeper than it meant to. In stories there has often been a artistic, dreamy, head in the clouds type that either delights or confuses the more stolid, logical, sensible and practical other character. Abbot and Costello, Rabbit and Briar Fox, Dexter and Dee-Dee, Billy and Mandy, Drop Dead Fred and everyone else in that movie, (or anyone in a Yahoo Serious movie other than Yahoo Serious) these dualistic Gemini archetypes are littered throughout western culture, and quite possibly others but I don't know them well enough to bring any popular characters to mind. I wonder how much of that is caused by the fundamental divide between high and low dopamine functioning people? Wild, zany, brash and in your face manic lifestyle caused primarily by having a lot of dopamine in your brain? With plenty of people around to facilitate the outcome at least in part because of the attention-seeking nature of the effect? This makes me long to attempt something similar. It makes me wonder who I would be on a long arc dopamine rush. Would I paint? Would I sing? Would I drive my friends and coworkers wild? Or lose everything in a dopamine fueled fumbling towards ecstasy? Who knows, but it's intriguing! It's as tempting as a siren song. If someone had those pills in front of me right now I don't know if I could resist trying them.

rincebrain 4y ago

I've actually been taking pramipexole for almost two years now for depression which mostly didn't blink for anything else in the past. I certainly do behave differently while on it, but not in a way that I think anyone who knew me would claim is inconsistent with my prior personality or behavior, just...less likely to fall into the inertial well that is depression stifling your actions. A strange anecdote, though - my doctor told me when I was tapering up on it "okay, for some medications they tell you you might feel ill taking it initially, but no, for this, I am going to promise you, you will feel sick, and how well you can tolerate feeling sick is going to be the limiter on how fast we taper this", and he was correct, though it was never that bad during the initial taper up, just mild discomfort... ...then one day, the pharmacy gave me 1x1mg pills instead of 4x0.25mg pills, from the same manufacturer, and suddenly I had horrific nausea if I was in anything moving faster than a brisk walk for hours after taking it, and it went away when I went back to the 4x0.25mg. Which was wild, as I've never had motion sickness from anything before. (It's also twice a day because the half-life is real short now, which is annoying, but c'est la vie.) Feel free to ask anything that comes to mind about it, if anecdata interests you.

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HH_Slm 4y ago